Explaining Your Cancer to Others: Avoiding Denial

Once the shock wears off, cancer patients may experience a huge range of emotions: denial, anger, bargaining, guilt, and depression. Most people eventually reach acceptance of the changes cancer has brought to their life, but it may take a while to get there. What makes this emotional stew even more complicated is dealing with family members and friends who are working through these emotions as well, and often in a different order or at a different rate than the patient.

Denial can be a helpful buffer that enables us focus on what we need to do in our daily lives and can help us get through difficult treatments. If people with an aggressive cancer diagnosis paid too much attention to statistics, they might get discouraged and give up. But denial can become a problem if it prevents us from following through on the medical treatments we need.

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A frequent complaint on the mailing lists I read goes something like this, "I'm so frustrated with my family. The doctor says I'll need months of chemo, surgery, and radiation, and that I'm at high risk for recurrence. My family refuses to understand that I am really sick. They keep on telling me that I'll be just fine. How can I get them out of denial?" Of course, letters come in from family members too. "My mother refuses to consider chemotherapy even though the doctor says she has a good chance to avoid recurrence if she has it. She says surgery is all she needs." Sometimes our family members need to be in denial because the truth is too painful. If that denial keeps them from supporting us emotionally or giving us practical help around the house, we may need a mediator to help us communicate our needs.

Both patients and family can expect to have moments of anger. Janet says, "I am most angry at the interruption this disease has had on my life. . . . To quote one of the folks in my support group, ‘I am the one that brings the casseroles, not the one that has the casseroles brought to me.' It angers me to be the one in need of help." Anger may be directed at the cancer itself, at God or Fate, at doctors, or at family members.

Sometimes we take out our anger about our situation on other people. I remember one friend of mine who became furious with the pharmacy near the end of her life. She was regularly angry with them for all kinds of little problems. She filed complaints and wrote long letters about their inconsideration and incompetence. The problems she was having with them were legitimate, but her level of fury was out of proportion to the offenses. However, turning her anger about her impending death on the pharmacist was more comfortable for her emotionally than blaming God or yelling at her doctors and family.

Our spouse and family members are also looking for a target for their anger, and this can lead to family misunderstandings. It's important for everyone to understand that the anger is a normal response to cancer, and to try to keep it focused on the real enemy--cancer. Parents need to realize that unusual anger in their children may be related to the changes in family routines because of the disease. If talking about the situation doesn't help, a trained counselor experienced in helping children deal with cancer in their families may be needed.

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Pounding on a pillow, writing about your emotions, or talking out your feelings with a friend can help you discharge some of your anger without endangering your relationships or hurting the feelings of someone you love.

Patients often use a lot of energy worrying about what they did to cause their cancer or feeling guilt because they can't keep up with all the activities they used to do. This guilt can be related to bargaining. "If I eat all organic foods, I'll get well." Their prayers may include lots of promises, "Lord, if you'll heal me, I'll never do anything bad again." These are normal reactions, but when bargaining doesn't bring a cure, depression can set in.

Depression is more than a sad day. It's a loss of interest in life and an inability to find pleasure. Cancer patients have a higher than average rate of depression. Just because the stress of cancer and its treatment makes depression understandable doesn't mean that it should be ignored. Anti-depressants can give patients the ability to cope with their diagnosis.

These emotions are often referred to as "stages" of grief, which implies to some people that they represent an orderly progression. In practice, not everyone goes through every stage and people may experience them in any order. Mary, an IBC survivor, told me, "In the nearly 10 years since my diagnosis, I've gone through all of these emotions over & over again...in order, out of order, up one side & down the other. As long as I exist, I think this vicious cycle of raw emotions will continue in my world."

There is no one right way to feel about cancer, but knowing about common emotional responses can help us. We won't take it as personally if our family members seem inappropriately angry, and we won't be embarrassed to ask our doctor for an anti-depressant. We'll be able to acknowledge our emotions and move on to accepting our situation.